Provider Demographics
NPI:1851350722
Name:ALBURO, MEDEL (PT)
Entity Type:Individual
Prefix:
First Name:MEDEL
Middle Name:
Last Name:ALBURO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 CALUMET AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2026
Mailing Address - Country:US
Mailing Address - Phone:219-548-8770
Mailing Address - Fax:219-548-8771
Practice Address - Street 1:3125 CALUMET AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2026
Practice Address - Country:US
Practice Address - Phone:219-548-8770
Practice Address - Fax:219-548-8771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007963A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist